For children who have had HIV-1 infection since birth, the combination drug therapies now used to treat HIV appear to protect against the heart damage seen before combination therapies were available, according to researchers in a National Institutes of Health network study.

In the early 1990s, children with HIV were not treated with anti-HIV therapy or were treated with only one drug. In recent years, children, like adults, have been treated with combinations of three or more anti-HIV medications. This combination approach is called highly active antiretroviral therapy, or HAART.

Before the widespread use of HAART, many children with HIV had chronic heart disease. In fact, heart failure was the underlying cause of death for 25 percent of HIV-infected children who died after age 10. However, doctors knew little about whether combination anti-HIV drug therapies could affect the heart. In this study, researchers examined heart structure and function of more than 500 children born to HIV-infected mothers. They then compared the data with results from the National Heart, Lung, and Blood Institute (NHLBI)-sponsored Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection study of HIV-infected children, conducted in the 1990s.

"The NIH has been committed to investigating the effects of HIV and its treatment on the heart," said study co-author Rohan Hazra, M.D., of the Maternal and Pediatric Infectious Disease Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), one of ten NIH institutes or offices that supported the study. "Our study indicates that anti-HIV medication may protect the heart."

The 500 children in the PHACS study were between 7 and 16 years old. Although all had been exposed to HIV before birth, some were HIV-infected and some remained HIV-uninfected. The HIV-infected children in the current study had, on average, received anti-HIV medications for at least twice as long as children in the study conducted in the 1990s. Roughly 80 percent of the children in the PHACS study were treated with HAART for five years or longer. Although 17 percent of the children in the earlier study received some HAART treatment, none had received HAART for as long as five years.

Researchers measured heart structure and function with echocardiography, a technique that uses sound waves to generate images of the heart. When comparing the echocardiograms among the children who took part in the current study, the researchers found that the hearts of the HIV-infected children were generally slightly less healthy than those of their HIV-uninfected counterparts.

About 45 percent of the children in the 1990s study had an enlarged heart or substantial damage to the heart muscle. In the HAART group, only 4 percent had heart damage.

"We know that before today's robust treatments were available, HIV-positive children were more likely to have heart infections and inflammation; many also died from heart failure," said Dr. Lipshultz. "This research followed a rigorous protocol, and the findings suggest that HAART, in addition to being good for treating HIV, does not appear to adversely affect the heart’s function."

First author Steven E. Lipshultz, M.D., of the University of Miami Miller School of Medicine, and his colleagues collaborated with Dr. Hazra and colleagues at the NHLBI in Bethesda, Md.; as well as with investigators at Harvard University in Boston; Tulane University in New Orleans; Baylor College and Texas Children’s Hospital in Houston; University of Illinois at Chicago; Frontier Science Technology and Research Foundation in Amherst, N.Y.; and Boston Children’s Hospital.

Their findings appear online in JAMA Pediatrics.

The research was conducted as part of the Pediatric HIV/AIDS Cohort Study (PHACS), which receives support from the NICHD, NHLBI, National Institute of Allergy and Infectious Diseases, National Institute of Deafness and Other Communication Disorders, National Institute of Dental and Craniofacial Research, National Institute of Mental Health, National Institute of Neurological Disorders and Stroke, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse and the Office of AIDS Research.